Aster’s experience-based learning and protocols helped it stayed ahead of the curve when it came to COVID management.

Recent COVID-19 trends in Kerala suggest the requirement for care might be higher in the state. Kerala is a victim of demographics and a high degree of co-morbidities in its people.The massive population with clinical diabetes also compounds the problem. The density of the population and the domestic and international migration additionally leads to an aggravated transmission rate. The residents of Kerala are politically conscious and celebrate elections as festivals. All these factors have led to a spike in the number of COVID cases in Kerala. In an exclusive interview with Arunima Rajan, Dr. Harish Pillai, CEO of Aster India, talks about Aster's recalibrated strategy in 2021 for states like Kerala and the need to accelerate the vaccination pace to break the transmission cycle of COVID.

What are the lessons (few important things) that your hospital has learned from practising medicine in 2020, and how are you making sure that you are prepared next time?

Aster's response to this pandemic was based on our institutional learning in handling the Nipah virus epidemic in Kerala in 2018 and 2019. In 2019, the index patient of the second Nipah outbreak was admitted at Aster Medcity, Kochi. This helped us to prime our systems more vigorously. Usually, we have mock drills for managing epidemics and pandemics in our JCI and NABH accredited hospitals. Our virtual COVID monitoring command centre facilitated the sharing of best practices across hospitals. Clinical algorithms were a useful tool in the efficient management of clinical cases during this pandemic.

Telemedicine got the clinical spotlight due to COVID. Has the system adapted to telemedicine?

Aster has been an early mover to join the healthcare revolution initiated by technology channel such as telemedicine. COVID accelerated our search in helping change both consumer behaviour as well as that of providers. The stringent lockdown experienced in the first quarter provided a rare window of connectivity only through telemedicine channels for our patients and for new patients who chose to interact with providers using this platform. We can safely declare that our system has now geared for the digital system than ever before.

How has the pandemic impacted your financial bottom-line? How can one mitigate such risks in the future?

The first quarter was a challenge for all healthcare providers in the country as footfalls got impacted by 80-90% in the out-patient area and 50-60% for in-patient areas. It was a struggle to preserve cash flows and liquidity in the system. We managed to mitigate these challenges by reducing our direct and indirect costs to the maximum extent possible. Several measures were adopted, such as proportionate pay cuts for employees at higher salary slab while preserving 100% salary outflow for those in minimum wages slab, seeking an extended credit period with vendors, renegotiating lease agreements with landlords, the extension of AMC / CMC contracts with OEM's, availing the RBI moratorium for repayment of interest and freeze on all CAPEX expenditure. All these measures helped us preserve liquidity in the system and offer core clinical services to the community.

What changes do you foresee in the healthcare delivery business model?

All providers will be looking at their cost levers under a microscope and will create a culture of efficiency, both from an operational service front and cost management. While the external environment is mostly not in our control, we can significantly impact the internal environment. Most providers will look at a sustainable model in the future, which will be a paradigm shift compared to the pre-COVID times.

Enumerate three structural changes to improve healthcare delivery in India?

The first structural change has to be to incentivize the laggards, incentivize states through the finance commission to give a more significant share of the centrally pooled tax income to those states that have made more generous social sectors like healthcare and education. There has to be a widely publicized national ranking of states per the healthcare indices to promote competition within a federal structure.
Continue the reformation in the medical education sector, including doctors, nurses and paramedical staff, to create a large cadre of competent and skilled healthcare workers for our country to export around the world.
Sustain the focus on holistic and preventive healthcare.

What role should the Government play going forward?

We hope that the government will focus on the following:

As announced in the latest Union Budget, increased allocation towards healthcare should not be a one-off event. This push should continue year after year till we achieve allocation to healthcare up to 5% of GDP.
Ensure up-grading quality standards across all providers through the Clinical Establishment Act roll-out in all States of the country.
The push ahead with the National Digital Health Mission by creating a unique health ID to promote the concept of data privacy pan India and interoperable electronic medical records will give proper access across the continuum of care and an individual's lifecycle.
We hope the government will act as a catalyst to continue regulatory changes that will produce more amount of healthcare workers in the form of graduate and post-graduate doctors, nurses and paramedical staff; in addition to the creation of an army of skilled healthcare workers, which will overall reduce the cost of the workforce for the nation. We can also become a net exporter of the healthcare workforce to the rest of the world.
The government should continue to incentivize domestic manufacturers, both in pharmaceuticals, medical consumables and medical equipment & technology fields. We can incentivize private sector participation in R&D and manufacturing activities. Overall, this will significantly impact economic output and help India's position as a global healthcare superpower.
The measures announced by the Union Budget to promote overall healthcare such as the provision of clean potable drinking water to all citizens, provision of LPG cylinders to the rural population, increased drive towards cleanliness and declaration of our country as Open Defecation-free by setting up more toilets, increased provision of nutritious meals to school-going children in public schools, the active promotion of yoga and fitness activities, promotion of wellness centres, incentivizing the population to go for health insurance schemes, more focus on preventive healthcare and vaccinations, are some of the few measures which will boost the macro health indicators in the country.

What are the measures you are adopting in your hospital to protect against COVID beyond masking and social distancing?

The most crucial measure is changing the behavioural attitudes and eliminating the lethargy and slackness in following protocols. Beyond masking and social distancing, we also adopt stringent hand hygiene measures and adopt WHO, and ICMR recommended protocols for managing in-patients, specifically for interventional/invasive procedures. We have also adopted a sizeable educational program for healthcare workers' safety when they go beyond the hospital while in transit to their homes and their family members' safety within their home environment.

What were some of the tech innovations that helped your organization in the battle? Anything that you want to acquire or is on your wish list?

We have rolled out a few applications

Teleconsultation app
Homecare app
Diagnostic lab app
COVID-19 self-assessment app

We are also promoting a Central portal called OneAster that will enable the consumer to interface with all our clinicians, seek appointments, payment gateways, access their diagnostic reports, etc. The organization has embarked on an extensive digital transformation journey that will bear fruit in this financial year.

Aster India's Recalibrated Strategy for 2021